Tachezy M, Anusic I, Rothenhöfer S, Gebauer F, Izbicki J R, Bockhorn M
Klinik und Poliklinik für Allgemein-, Viszeral- und Thoraxchirurgie, Universitätsklinikums Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland,
Chirurg. 2015 Sep;86(9):881-8. doi: 10.1007/s00104-014-2913-9.
Appendectomy is the most frequently performed non-elective surgical procedure in general surgery. Despite the questionable benefit, inflammatory markers, such as leukocyte count and C-related protein (CRP) are often determined before and after the surgical procedure. Clinicians are not infrequently confronted with the question whether a patient can be discharged despite an increase in inflammatory laboratory parameters.
The aim of the current study was to retrospectively evaluate the clinical course of patients after appendectomy and the correlation with inflammatory laboratory findings.
A total of 969 patients underwent a surgical procedure due to clinically suspected acute appendicitis. All clinical, laboratory and histopathological data were obtained from the patient records and a quality control database. Laboratory results were correlated with clinical and histopathological data (e.g. t-test, χ (2)-test, regression analysis and ROC curves).
In patients without acute appendicitis operative trauma caused an increase in CRP up to a median of 31 mg/dl on the first postoperative day and up to 47 mg/dl on postoperative day 2. The overall morbidity was 6.2%. The strongest predictive parameter for complications was a CRP of more than 108 mg/l on the first postoperative day with an odds ratio of 16.6 (96% CI 6.4/42.8, p < 0.001, specificity 88% and sensitivity 69%). Patients with CRP values below the threshold suffered from complications in 1.1 % of cases in contrast to patients above the threshold in 16.8% of cases (p < 0.001).
A moderate postoperative elevation of CRP values is not a general contraindication for discharge; however, postoperative determination of CRP serum values after appendectomy might be an effective predictor for complications and should therefore be measured in the clinical routine.
阑尾切除术是普通外科最常进行的非选择性手术。尽管其益处存疑，但在手术前后通常会检测炎症指标，如白细胞计数和C反应蛋白（CRP）。临床医生经常会面临这样的问题：尽管炎症实验室参数升高，患者是否可以出院。
本研究的目的是回顾性评估阑尾切除术后患者的临床病程及其与炎症实验室检查结果的相关性。
共有969例因临床怀疑急性阑尾炎而接受手术的患者。所有临床、实验室和组织病理学数据均从患者病历和质量控制数据库中获取。将实验室结果与临床和组织病理学数据进行相关性分析（如t检验、χ²检验、回归分析和ROC曲线）。
在无急性阑尾炎的患者中，手术创伤导致术后第1天CRP中位数升高至31mg/dl，术后第2天升高至47mg/dl。总体发病率为6.2%。并发症的最强预测参数是术后第1天CRP超过108mg/l，比值比为16.6（96%CI 6.4/42.8，p<0.001，特异性88%，敏感性69%）。CRP值低于阈值的患者并发症发生率为1.1%，而高于阈值的患者并发症发生率为16.8%（p<0.001）。
术后CRP值适度升高并非出院的普遍禁忌证；然而，阑尾切除术后测定CRP血清值可能是并发症的有效预测指标，因此应在临床常规中进行检测。
